Abstract
Objective: During outbreaks, healthcare workers may encounter mental health challenges, including an increased risk of infection and burnout. Physical inactivity due to widespread restrictions may significantly worsen these adverse effects. This study aims to assess burnout and physical activity levels among healthcare workers in hospitals during the COVID-19 outbreak and to examine the relationship between these factors.
Methods: This cross-sectional study involved 294 healthcare professionals, including nurses, midwives, health technicians, physiotherapists, laboratory technicians, and emergency medical technicians, working in outpatient or inpatient clinics at a university hospital, separate from the COVID-19-related study units. Research data were collected from November 10, 2021, to February 10, 2022. The Maslach Burnout Inventory, International Physical Activity Questionnaire, and a sociodemographic form were used as data collection tools.
Results: Among the participants included in the study, 63.9% were female, 36.1% were male, and the mean age was 29.40±6.39 (min: 19, max: 58). Additionally, 70.1% of the participants were employed in units related to COVID-19. The emotional exhaustion and desensitization subscales were higher in physicians and nurses working in COVID-19 units (p<0.05). Furthermore, 13.9% of the participants in this study met the criteria for sufficient physical activity levels. Physical activity levels were greater among single participants (p<0.05). However, there was no significant relationship between the participants’ burnout status and physical activity levels (p>0.05).
Conclusion: This study found that burnout levels among physicians and nurses were higher than those of other healthcare professionals. Additionally, burnout levels were elevated in employees working in units related to COVID-19. The physical activity levels of healthcare professionals participating in our study were low. However, no significant relationship was observed between participants’ burnout and physical activity levels.
Keywords: Pandemic, COVID-19, health personnel, physical activity, burnout
Introduction
In situations that cause mass trauma, such as the COVID-19 pandemic, healthcare workers are the group at the highest risk and most affected, playing a vital role in the healthcare system.[1] During these outbreaks, particularly those who manage cases directly, they may face mental health issues like burnout, along with a high risk of infection.[2] Burnout is an employee’s inability to provide professional care for the people they serve while performing their job or their psychological distancing from their career as a response to excessive stress and dissatisfaction.[3] Today, burnout has become an increasingly significant issue, characterized by emotional fatigue, a diminished sense of personal accomplishment, and feelings of cynicism.[4]
Doctors and nurses are among the occupational groups at the highest risk for burnout. Factors such as workload, irregular and prolonged working hours, the challenge of understanding patients in difficult situations, the necessity of establishing a positive relationship with the patient, and the frequent need to take responsibility all contribute to increasing burnout.[5] Physical activity is a fundamental means of enhancing physical and mental health. Conversely, physical inactivity is a significant risk factor for cardiovascular and musculoskeletal disorders, type 2 diabetes, hypertension, certain oncological diseases, and psychological disorders.[6]
Physiological changes resulting from physical activity can reduce individuals’ sensitivity to ongoing stress, enabling them to cope better with workplace stress without feeling overwhelmed. Consequently, this may decrease the risk of burnout.[7] Studies on the physical activity levels of healthcare workers indicate that physical activity levels are relatively low, while inactivity levels are high.[8,9]
Healthcare workers on the front lines of the COVID-19 outbreak faced an increased risk of burnout. They had limited opportunities for physical activity due to heavy workloads and challenging social conditions arising from restrictions. This study aimed to assess burnout and physical activity levels among healthcare workers during the COVID-19 pandemic and to explore the relationship between these factors.
Materials and Methods
Study design and participants
This cross-sectional study was conducted at a university hospital between November 10, 2021, and February 10, 2022. The study population consisted of physician residents and other healthcare professionals (nurses, midwives, health technicians, physiotherapists, laboratory technicians, and emergency medical technicians) who worked independently in units unrelated to COVID-19 at the university hospital. Our study population included 417 residents, 478 nurses, 24 laboratory technicians, 12 physiotherapists, 50 health technicians, and 67 emergency medical technicians, totaling 1048 individuals. The Epi Info program was used to calculate the sample size, aiming to reach at least 281 participants with a 50% prevalence and a 5% margin of error. Based on the percentages of the occupational groups in the population, we reached at least 112 residents, 129 nurses, and 40 other healthcare personnel.
Data collection
The Maslach Burnout Scale, which consists of 22 items and was adapted into Turkish by Ergin[10], the International Physical Activity Questionnaire, comprising 7 items along with a Turkish validity and reliability study conducted by Öztürk[11], and a sociodemographic data form, were utilized in the study. In the Maslach Burnout Scale, high scores on the emotional exhaustion and depersonalization subscales indicate significant levels of burnout. In contrast, low scores on the personal accomplishment subscale suggest high levels of burnout. Higher scores on the International Physical Activity Questionnaire are regarded as more favorable.
Data analysis
SPSS software for Windows (version 28.0; IBM Corp, Armonk, NY.) was used to evaluate and analyze the data obtained from the study. The categorical variables in the study were presented as numbers and percentages to illustrate the distribution of patients, while numerical data were reported as means and standard deviations. Skewness-Kurtosis values were employed to determine whether the distribution of the variables was normal. Variables with a normal distribution were compared using the Student’s t-test, while those not exhibiting a normal distribution were compared using the Mann-Whitney U and Kruskal-Wallis tests. The statistical significance level of the obtained data was interpreted with a “p<0.05” value.
Ethical approval
The ethics committee decision report numbered 20.478.486/947 was approved by the University Medical Faculty Health Sciences Ethics Committee on 22 September 2021. Additionally, approval was obtained from the Hospital’s Director to conduct this research on hospital staff. During the study, informed written consent was acquired from the volunteers who agreed to participate.
Results
The research involved 294 participants, of whom 63.9% were female and 36.1% were male. Among them, 47.3% (n=139) were nurses, while 39.1% (n=115) served as residents. The mean age of the participants was 29.40±6.39 years (min: 19, max: 58). Additionally, 33.3% of participants lived alone, 47.6% cohabited with a spouse or children, and 56.5% had an income that equaled their expenses (Table 1).
| Table 1. Distribution of participants according to sociodemographic characteristics | ||
| Variables |
|
|
| Sex | Female |
|
| Male |
|
|
| Occupation | Resident |
|
| Nurse |
|
|
| Physiotherapist |
|
|
| Laboratory |
|
|
| Health Technician |
|
|
| Marital Status | Single |
|
| Married |
|
|
| Other |
|
|
| Living Environment | Alone |
|
| With Mother, Father, or Other Relative |
|
|
| With Spouse, Children |
|
|
| Other |
|
|
| Number of Children | No Children |
|
| 1 Child |
|
|
| 2 Children |
|
|
| More Than 2 Children |
|
|
| Income Level | Less Than Expenses |
|
| Equal to Expenses |
|
|
| More Than Expenses |
|
|
| COVID-19 Related Unit Assignment | Yes |
|
| No |
|
|
| Total |
|
|
Among the participants, 70.1% work in a unit directly related to the pandemic, while 20.1% have at least one chronic disease. Additionally, 25.9% have been diagnosed with COVID-19, and 77.2% believe they are healthy (Table 2).
| Table 2. Participants' health status information | ||
| Variables |
|
|
| Chronic Disease | Yes |
|
| No |
|
|
| COVID-19 | Diagnosed |
|
| Not Diagnosed |
|
|
| Perceived health situation | Very Healthy |
|
| Healthy |
|
|
| Not Very Healthy |
|
|
| Not Healthy at All |
|
|
The mean total score on the Maslach Burnout Scale (MBS) for the participants was 68.32±9.76 (min: 44.0-max: 99.0) points. The mean scores for the MBS subscales were as follows: emotional exhaustion (EE) 28.18±6.67 (min: 12.0-max: 44.0), depersonalization (D) 11.76±4.43 (min: 5.0-max: 24.0), and personal accomplishment (PA) 28.36±5.41 (min: 13.0-max: 99.0).
When comparing employment in units related to COVID-19 with the sub-dimensions of the ITS, it was found that employees in these units experienced greater exhaustion than those who were not, regarding the total score, EE, and D subscale scores (p<0.001, p = 0.027, p<0.001, respectively). However, no statistically significant difference was observed in the MBS and its subscales among individuals diagnosed with COVID-19.
It was found that employees who felt unhealthy experienced greater exhaustion regarding DT and total scores from the sub-dimensions of MBS compared to those who felt healthy (p=0.001, p=0.036, respectively).
Physicians and nurses displayed statistically significantly higher levels of emotional exhaustion than other healthcare professionals (p<0.001 and p=0.002, respectively). In the depersonalization subgroup, physicians scored higher than nurses and other healthcare professionals (p=0.001 and p<0.001, respectively). Nurses scored significantly higher in the depersonalization subgroup than other healthcare professionals (p=0.020). When examining the relationship between the PA subgroup and occupation, physicians viewed themselves as more successful than nurses and other healthcare professionals (p=0.014 and p=0.018, respectively). No statistically significant difference was identified between nurses and other healthcare workers when assessing the PA subgroup (p<0.05) (Table 3).
| *p<0.05 statistically significant. #Student-t test, †Kruskal Wallis, $Mann-Whitney U test |
|||||
| Table 3. Comparison of Maslach Burnout Scores according to socio-demographic characteristics | |||||
| Variables |
Mean±SD |
Mean±SD |
Mean±SD |
Mean±SD |
|
| Sex | Female |
|
|
|
|
| Male |
|
|
|
|
|
| Occupation† | Resident |
|
|
|
|
| Nurse |
|
|
|
|
|
| Others |
|
|
|
|
|
| Marital Status# | Single |
|
|
|
|
| Married |
|
|
|
|
|
| Living Environment$ | Alone |
|
|
|
|
| Not Alone |
|
|
|
|
|
| Child(ren) | Yes |
|
|
|
|
| No |
|
|
|
|
|
| Income Level | Less Than Expenses |
|
|
|
|
| Equal to Expenses |
|
|
|
|
|
| More Than Expenses |
|
|
|
|
|
| COVID-19 Related Unit Assignment$ | Yes |
|
|
|
|
| No |
|
|
|
|
|
| Chronic Disease | Yes |
|
|
|
|
| No |
|
|
|
|
|
| COVID-19 | Diagnosed |
|
|
|
|
| Not Diagnosed |
|
|
|
|
|
| Perceived health situation$ | Healthy |
|
|
|
|
| Unhealthy |
|
|
|
|
|
45.6% of participants had low activity levels, with 40.5% not engaging in physical activity. Single participants exhibited significantly higher levels of physical activity (p<0.05). Comparing the scores obtained by participants in the sub-dimensions of the MBS regarding physical activity levels revealed no statistically significant difference in the evaluations of EE, D, and PA.
Discussion
This study highlights significant levels of burnout among healthcare workers, particularly in emotional burnout and depersonalization among those working in pandemic-related units. Doctors and nurses exhibited considerably higher emotional burnout and depersonalization than other healthcare workers, possibly due to the emotional demands of their roles. No significant association was found between activity level and burnout. However, most participants reported low or no physical activity, suggesting that the protective effects of physical activity may be limited under high-stress conditions such as the pandemic.
When analyzing the literature on the extent to which gender affects burnout, various results emerge. In this study, no significant relationship was found between gender and burnout level. Similar findings were reported in the study conducted by Dinibütün et al.[12] In contrast, some research indicates that women’s emotional exhaustion levels are higher.[13,14]
Most literature publications suggest no connection between marital status and burnout.[12,15] A study conducted on physicians during the COVID-19 pandemic in Türkiye found that marital status did not influence emotional exhaustion, depersonalization, or burnout.[13] In contrast to the literature, this study indicated that married participants had higher scores on the personal accomplishment subscale.
Healthcare workers are among the professional groups where burnout symptoms are most frequently encountered. Many studies show that nurses are more prone to burnout than other healthcare professionals.[16-18] In a study by Lasalvia et al., nurses and physician assistants were found to experience higher levels of burnout than other professions.[19] Sung et al. demonstrated that doctors and nurses are at greater risk for burnout than other health professionals.[20] This study reveals that the burnout status of healthcare professionals is high. However, since there was no analysis of the participants’ burnout before the pandemic, the effect of the COVID-19 pandemic on this situation cannot be clearly expressed.
The impact of the living environment on burnout is a somewhat under-researched topic in the literature. In a study conducted by Elhadi et al. on healthcare workers, it was found that there was no relationship between lifestyle and three sub-dimensions of burnout.[15] This study revealed no statistical difference regarding the emotional exhaustion sub-dimension and total score. Lasalvia et al. emphasized that living alone increases emotional exhaustion and depersonalization.[19] This study identified a statistically significant difference between lifestyle and the depersonalization and low personal accomplishment subscales.
Healthcare workers on the front lines during the COVID-19 pandemic face challenges due to increased workloads, long hours, and the risk of exposure to positive cases.[21] The study by Arpacıoğlu et al. found that employees providing direct service to COVID-19 patients experienced statistically significant emotional exhaustion, depersonalization, and total scores.[22] In a study conducted with family physicians, it was found that emotional exhaustion and depersonalization rates increased with more frequent contact with COVID-19 patients.[23] Aligned with the studies in the literature, this study revealed that health professionals who provided direct service to COVID-19 patients experienced statistically significant emotional exhaustion, depersonalization, and total scores.
In a study conducted by Hoşgör et al. on 120 healthcare workers in Istanbul, no significant differences were found between the status of having a positive diagnosis of COVID-19 and all sub-dimensions of the burnout scale.[1] Similar to the literature, this study also found no significant difference between the status of having a positive diagnosis of COVID-19 and all sub-dimensions of the burnout scale. In contrast, the study conducted by Türkili et al. found high levels of depression and depersonalization in family physicians who were tested for COVID-19 and whose results were positive.[23]
In a study conducted by Çolak et al. on healthcare workers, physical activity levels were analyzed according to the International Physical Activity Questionnaire (IPAQ). It was found that 51.6% of the participants were inactive, 41.4% were lowly active, and only 6.9% had adequate physical activity levels.[24] In studies of healthcare workers before and after the COVID-19 pandemic, low physical activity levels remained similar.[25,26] A study involving healthcare workers in Singapore compared physical activity levels before and after the COVID-19 lockdown. It was found that significantly less physical activity was performed during the lockdown period.[27] Similarly, 45.6% of the participants in this study were found to have a low level of activity, 40.5% were not physically active, and 13.9% had an adequate level of activity.
When the literature was examined, a negative relationship between burnout and physical activity was identified in a significant portion of the studies comparing these two variables. However, some studies revealed no significant difference between burnout and physical activity. In the study conducted by Aydın et al. on nurses during the COVID-19 pandemic, no significant relationship was found between physical activity and burnout levels.[9] In the study conducted by Cecil et al. on medical faculty students, a negative relationship was identified between increased physical activity levels and Emotional Exhaustion levels; still, no significant relationship was observed between the two variables.[28] In the study analysis by Souza et al. on university students, physical activity was significantly associated with burnout symptoms, yet the adjusted model revealed no significant difference between the two.[29] Similarly, this study found no significant difference between physical activity and burnout.
Limitations of the study
This study has several limitations. First, it is confined to a university hospital; large-scale studies with more participants are recommended. Second, because resident physicians were included in the study, information could not be provided for other physicians.
Conclusion
This study demonstrates that burnout is a significant issue among healthcare professionals, particularly those working in pandemic-related units. Doctors and nurses exhibit the highest levels of emotional exhaustion and depersonalization. Living alone and being single are linked to low personal accomplishment. The emotional exhaustion and depersonalization subscales are elevated in those working in COVID-19-related units and among those experiencing burnout. When analyzing participants by gender, parental status, income level, chronic illness, and COVID-19 diagnosis, no differences in burnout are observed. The findings also indicate that most healthcare professionals engage in low or no physical activity, and no significant relationship is found between physical activity levels and burnout, aligning with some previous studies. Although the cross-sectional design and absence of pre-pandemic data restrict causal interpretations, the results underscore the need for targeted interventions to support the mental health and well-being of healthcare professionals (especially those in high-risk roles), regardless of lifestyle or demographic background. Future longitudinal studies are essential for better understanding the long-term effects of pandemic-related stressors on burnout and the potential protective roles of physical activity and other factors.
Ethical approval
This study has been approved by the Manisa Celal Bayar University, Faculty of Medicine Dean’s Office, Health Sciences Ethics Committee (approval date 22.09.2021, number 20.478.486/947). Written informed consent was obtained from the participants.
Source of funding
The authors declare the study received no funding.
Conflict of interest
The authors declare that there is no conflict of interest.
References
- Hoşgör DG, Tanyel T, Cin S, Demirsoy SB. Covıd-19 pandemisi döneminde sağlık çalışanlarında tükenmişlik: İstanbul ili örneği. Avrasya Sosyal ve Ekonomi Araştırmaları Dergisi. 2021;8(2):372-386.
- Wu P, Fang Y, Guan Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry. 2009;54(5):302-311. https://doi.org/10.1177/070674370905400504
- Aslan H, Alpaslan NZ, Aslan O, Ünal M. Hemşirelerde tükenme, iş doyumu ve ruhsal belirtiler. Nöro Psikiyatri Arşivi. 1996;33:192-199.
- Koutsimani P, Montgomery A, Georganta K. The relationship between burnout, depression, and anxiety: a systematic review and meta-analysis. Front Psychol. 2019;10:284. https://doi.org/10.3389/fpsyg.2019.00284
- Haran S, Devrimci Özgüven H, Ölmez Ş, Sayı I. Ankara Üniversitesi Tıp Fakültesi Hastaneleri ve Ankara Numune Hastanesinde çalışan doktor ve hemşirelerde tükenmişlik süzeyleri. Kriz Dergisi. 1997;6:75-84. https://doi.org/10.1501/0000890
- Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. https://doi.org/10.1136/bjsports-2020-102955
- Ochentel O, Humphrey C, Pfeifer K. Efficacy of exercise therapy in persons with burnout. A systematic review and meta-analysis. Journal of Sports Science and Medicine. 2018;17:475-484.
- Kılınç F, Tosun N. Hemşirelerin fiziksel aktivite düzeyleri ile yaşam kaliteleri arasındaki ilişkinin incelenmesi: tanımlayıcı bir araştırma. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi. 2020;6:207-215. https://doi.org/10.30569/adiyamansaglik.709435
- Aydın Y, Kamuk YU. Hemşirelerin fiziksel aktivite düzeylerinin, yaşam kalitesi ve tükenmişlik düzeylerine etkisi. Spor Bilimleri Araştırmaları Dergisi. 2021;6:88-105. https://doi.org/10.25307/jssr.902511
- Ergin C. Doktor ve hemşirelerde tükenmişlik ve Maslach Tükenmişlik Ölçeğinin uyarlanması. VII. Ulusal Psikoloji Kongresi, Ankara; 2002.
- Öztürk M. Üniversitede eğitim-öğretim gören öğrencilerde uluslararası fiziksel aktivite anketinin geçerliliği ve güvenirliği ve fiziksel aktivite düzeylerinin belirlenmesi [Master’s thesis]. Hacettepe Üniversitesi Sağlık Bilimleri Enstitüsü, Ankara; 2005.
- Dinibutun SR. Factors associated with burnout among physicians: an evaluation during a period of COVID-19 pandemic. J Healthc Leadersh. 2020;12:85-94. https://doi.org/10.2147/JHL.S270440
- Kantek F, Kabukcuoğlu K. Hemşirelerde tükenmişlik: ilgili faktörlerin meta analizi. Journal of Human Sciences. 2017;14(2):1242-1254. https://doi.org/10.14687/jhs.v14i2.4431
- Purvanova R, Muros J. Gender differences in burnout: a meta-analysis. J Vocat Behav. 2010;77:168-185. https://doi.org/10.1016/j.jvb.2010.04.006
- Elhadi M, Msherghi A, Elgzairi M, et al. Burnout syndrome among hospital healthcare workers during the COVID-19 pandemic and civil war: a cross-sectional study. Front Psychiatry. 2020;11:579563. https://doi.org/10.3389/fpsyt.2020.579563
- Giusti EM, Pedroli E, D’Aniello GE, et al. The psychological impact of the COVID-19 outbreak on health professionals: a cross-sectional study. Front Psychol. 2020;11:1684. https://doi.org/10.3389/fpsyg.2020.01684
- Stathopoulou H, Karanikola MNK, Panagiotopoulou F, Papathanassoglou EDE. Anxiety levels and related symptoms in emergency nursing personnel in Greece. J Emerg Nurs. 2011;37(4):314-320. https://doi.org/10.1016/j.jen.2010.03.006
- Havaei F, Ma A, Staempfli S, MacPhee M. Nurses’ workplace conditions impacting their mental health during COVID-19: a cross-sectional survey study. Healthcare (Basel). 2021;9(1):84. https://doi.org/10.3390/healthcare9010084
- Lasalvia A, Amaddeo F, Porru S, et al. Levels of burn-out among healthcare workers during the COVID-19 pandemic and their associated factors: a cross-sectional study in a tertiary hospital of a highly burdened area of north-east Italy. BMJ Open. 2021;11(1):e045127. https://doi.org/10.1136/bmjopen-2020-045127
- Sung CW, Chen CH, Fan CY, et al. Burnout in medical staffs during a coronavirus disease (COVID-19) pandemic. The Lancet. 2020. https://doi.org/10.2139/ssrn.3594567
- Li W, Yang Y, Liu ZH, et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. Int J Biol Sci. 2020;16(10):1732-1738. https://doi.org/10.7150/ijbs.45120
- Arpacıoğlu MS, Z. Baltaci, B. Unubol. Burnout, fear of Covid, depression, occupational satisfaction levels and related factors in healthcare professionals in the COVID-19 pandemic. Cukurova Med J. 2021;46(1):88-100.
- Türkili S, Uysal Y, Tot Şenel. Aile hekimlerinde Korona Virüs salgını nedeniyle yaşanılan zorluklar, kaygı ve tükenmişlik durumlarının incelenmesi. Turkish Journal of Family Medicine and Primary Care. 2021;15(2); 348-356. https://doi.org/10.21763/tjfmpc.853344
- Çolak M, Erol S. Sağlık çalışanlarının genel sağlık durumu, fiziksel aktivite düzeyleri ve etkileyen faktörler. Journal of Anatolia Nursing and Health Sciences. 2021;24(2):139-147. https://doi.org/10.17049/ataunihem.582280
- Korkmaz N, Demirkan N. Hastanede çalışan sağlık personellerinin fiziksel aktivite düzeyinin değerlendirilmesi. Sport Sciences. 2017;12(4):52-62. https://doi.org/10.12739/NWSA.2017.12.4.2B0111
- Arvidson E, Börjesson M, Ahlborg G, Lindegård A, Jonsdottir IH. The level of leisure time physical activity is associated with work ability-a cross sectional and prospective study of health care workers. BMC Public Health. 2013;13:855. https://doi.org/10.1186/1471-2458-13-855
- Kua Z, Hamzah F, Tan PT, Ong LJ, Tan B, Huang Z. Physical activity levels and mental health burden of healthcare workers during COVID-19 lockdown. Stress Health. 2022;38(1):171-179. https://doi.org/10.1002/smi.3078
- Cecil J, McHale C, Hart J, Laidlaw A. Behaviour and burnout in medical students. Med Educ Online. 2014;19:25209. https://doi.org/10.3402/meo.v19.25209
- de Souza RO, Ricardo Guilherme F, Elias RGM, et al. Associated determinants between evidence of burnout, physical activity, and health behaviors of university students. Front Sports Act Living. 2021;3:733309. https://doi.org/10.3389/fspor.2021.733309
Copyright and license
Copyright © 2025 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
